title: Acute epididymitis in ultrasound: results of a prospective study with baseline and follow-up investigations in 134 patients.
abstract: OBJECTIVE
  To perform a comprehensive follow-up analysis of ultrasonographic scrotal features and associated signs in patients with acute epididymitis.
  
  
  METHODS
  Between 2007 and 2012, 134 adults (median age 54 years) with acute epididymitis underwent scrotal ultrasonography and palpation at first presentation and after 2 weeks and 3 months.
  
  
  RESULTS
  At first presentation, 61 patients (45.5%) had hydrocele, 63 (47.0%) concomitant orchitis, and 8 (5.9%) epididymal abscess. Epididymitis was predominantly located in 24 cases (17.9%) in the head, 52 cases (38.8%) in the tail, and 58 cases (43.3%) in both. On the affected side, testicular volume was 16.9 ± 6.8 ml and peak systolic velocity of the testicular artery was 23.7 ± 7.5 cm/s, compared to the healthy side with 12.3 ± 4.4 ml and 9.5 ± 3.6 cm/s respectively (P<0.001). Concomitant orchitis was associated with hydrocele, testicular enlargement and pain (P<0.01). Orchiectomy due to secondary testicular infarction was necessary in four cases, while in all other patients ultrasound parameters normalized. Only 16/90 patients (17.8%) showed a persistent epididymal swelling after 3 months.
  
  
  CONCLUSIONS
  Common ultrasound features include hydrocele, epididymal enlargement, hyperperfusion, and testicular involvement. Under conservative treatment, ultrasound parameters normalize without evidence of testicular atrophy even in patients with epididymal abscess or concomitant orchitis.
authors.affiliation: Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany. Electronic address: adrian.pilatz@chiru.med.uni-giessen.de.
authors.forename: A
authors.initials: A
authors.lastname: Pilatz
authors.forename: F
authors.initials: F
authors.lastname: Wagenlehner
authors.forename: T
authors.initials: T
authors.lastname: Bschleipfer
authors.forename: H-C
authors.initials: HC
authors.lastname: Schuppe
authors.forename: T
authors.initials: T
authors.lastname: Diemer
authors.forename: T
authors.initials: T
authors.lastname: Linn
authors.forename: W
authors.initials: W
authors.lastname: Weidner
authors.forename: B
authors.initials: B
authors.lastname: Altinkilic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004823:Epididymitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009920:Orchitis / Q000175:diagnosis* / Q000453:epidemiology; D010173:Palpation / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Epididymitis; Orchitis; Scrotal ultrasound; Testicular artery; Testicular atrophy